eating well type 1
TRANSCRIPT
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Eating well with Type 1 diabetes
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Contents
Introduction 3
Your diet and diabetes 4
Ten steps to eating well 9
Your questions answered 12
A healthy balance 15
Getting the balance right 16
Know your labels 18
Sources of support and information 22
About Diabetes UK 23
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Your diet and diabetes
What is Type 1 diabetes?Diabetes mellitus is a condition in which the amount of glucose
(sugar) in the blood is too high because the body cannot use it
properly. Glucose comes from the digestion of foods or drinks
containing carbohydrate and from the liver which makes glucose.
Insulin is vital for life. It is a hormone produced by the pancreas,
that helps glucose to enter the cells where it is used as fuel by the
body. Type 1 diabetes develops when the insulin-producing cells(beta cells) in the pancreas have been destroyed and so no insulin
can be produced. Nobody knows for sure why this happens but
the most likely cause is the body’s immune system developing an
abnormal reaction to the cells (autoimmune). This may be triggered
by a virus or other infection.
Good blood glucose control is important in the management of
diabetes. Because of the link between eating carbohydrate andblood glucose levels, we have answered some
of the most common questions about carbohydrate below.
What is carbohydrate?Carbohydrate is a nutrient that is an important source of energy
in the diet. All carbohydrates are broken down into glucose,
which is used by the body’s cells as fuel. Carbohydrate can beclassified in a number of different ways, but essentially there are
two main types, starchy carbohydrates and sugars.
Starchy carbohydrates include foods like bread, pasta, chapatis,
potatoes, yam, noodles, rice and cereals.
Sugars include table sugar (caster, granulated etc), and can
also be found in fruit (fructose), and some dairy foods (lactose).
They can often be identified on food labels as those ingredientsending with –ose.
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Breakfast Lunch Dinner
5
Another type of food that can affect blood glucose levels are
nutritive sweeteners, including polyols. If you are unsure what
these are, they tend to end in –ol , eg sorbitol, maltitol, xylitol
and mannitol.
Why is carbohydrate important?Since all carbohydrate is converted into glucose, some peoplewith diabetes wonder if it would be better not to have anycarbohydrate in their diet to keep their blood glucose levelsunder control. This is not recommended as:• glucose from carbohydrate is essential fuel for the body,
especially the brain• high fibre carbohydrates, such as wholegrain and fruit also play
an important role in the health of the gut
• some carbohydrates may help you to feel fuller for longer after
eating.
How does carbohydrate affect my diabetes?
All carbohydrate is converted into glucose. In someone withoutdiabetes the glucose level in the blood would be matched by
insulin produced by the pancreas as shown below:
I n s u l i n l e
v e l s i n b
l o o d
Normal insulin release:
Insulin produced by pancreas
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In Type 1 diabetes the same principle applies but instead of the
pancreas producing insulin, the carbohydrate is matched by
insulin injections or an insulin pump. Most people follow twice
daily or basal bolus insulin regimes as explained in the following
section.
If you are taking two injections a day, knowing the amount of
carbohydrate you are eating can help you balance it with your
insulin so that your blood glucose levels stay under control. You
should eat roughly the same amount of carbohydrate at similar
times each day. For example, at your main meal try to fill about
a third of your plate with starchy carbohydrate.
More carbohydrate than usual can cause blood glucose levels
to go too high and less than usual can cause a hypo (low blood
glucose levels).
I n s u l i n
e f f e c t
Lunch DinnerBreakfast
Insulininjection
Short acting insulin
Long acting insulin
Twice daily insulin:
Insulininjection
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I n s
u l i n
e f f e c t
Lunch DinnerBreakfast
Insulininjection
Short acting insulin
Long acting insulin
Basal bolus insulin:
Insulininjection
Insulininjection
Insulininjection
If you are using a basal bolus insulin regime or pump you canbe much more flexible in adjusting the timings of and theamount of insulin you take with the amount of carbohydrate
you eat and drink. This can be done by ‘counting carbohydrates’.See ‘What is carbohydrate counting?’– page 8. If you preferfixed times and doses of insulin, it may be better to follow theprinciples for the twice daily insulin regime (left page).
How much do I need?The actual amount of carbohydrate that the body needs variesdepending on your age, weight and activity levels, but it shouldmake up about half of what you eat and drink over the courseof a week. For good health most of this should come from starchycarbohydrate, fruits and some dairy foods, with a small amount ofyour total carbohydrate to come from added sugar or table sugar.(see pages 15 -17 for a clearer guide).
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What is carbohydratecounting?Carbohydrate counting is a method
of matching your insulin requirementswith the amount of carbohydrate you
eat and drink. For many people with
diabetes, it is an effective way
of managing the condition that,
once mastered, will lead to
better blood glucose control,
greater flexibility and freedomof lifestyle. It is an approach that
requires a great deal of time and effort
with guidance from a diabetes healthcare
professional. To do it successfully you will need to learn all about
carbohydrates, learn how to adjust your insulin and be dedicated
to monitoring your blood glucose levels frequently.
How can I learn more aboutcarbohydrate counting?You will need the support of healthcareprofessionals either in the form of your diabeteshealthcare team or through one of thestructured carbohydrate-counting courses. Talkto your diabetes healthcare team about coursesavailable in your area. It is important that thecourse you attend meets certain criteria.Although there is no formal accreditation scheme
you can find courses that have met criteria set by theDiabetes Education Network by visiting:www.diabetes.nhs.uk/downloads/Type_1_Education_Network.pdfCourses don’t suit everyone so, if this isn’t for you, talk to yournurse and dietitian about arranging some one-to-oneeducation. Also see www.diabetes.org.uk/carb-counter
?
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Ten steps to eating wellAlthough balancing carbohydrate and insulin is the most
important task in managing your diabetes, eating a healthybalanced diet plays a vital role in benefiting your health by
keeping your weight, blood fats and blood pressure under control.
Eat three meals a day. Avoid skipping meals and space out
your breakfast, lunch and evening meal over the day. This will help
control your appetite and your blood glucose levels especially if
you are on twice daily insulin.
At each meal include starchy carbohydrate foods
such as bread, pasta, chapatis, potatoes, yam, noodles,
rice and cereals. The high fibre varieties of starchy
foods will also help to maintain the health of your
digestive system and prevent problems
such as constipation. The amount of
carbohydrate you eat is important in
controlling your blood glucose levels.
Cut down on the fat you eat,
particularly saturated fats, as a low fat diet benefits health. Choose
unsaturated fats or oils, especially monounsaturated fat (eg olive
oil and rapeseed oil) as these types of fats are better for your
heart. As fat is the greatest source of calories, eating less fat will
help you to lose weight if you need to. To cut down on the fat youeat, here are some tips:
• Use less saturated fat by having less butter, margarine and cheese.
• Choose chicken, turkey, lean meat and fish as low fat alternatives
to fatty meats.
• Choose lower fat dairy foods such as skimmed or semi-skimmed
milk, low fat or diet yogurts, reduced fat cheese and lower fat
spreads.
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2
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• Grill, steam or oven bake instead of frying or cooking with oil or
other fats.
• Watch out for creamy sauces and dressings and swap for tomato-
based sauces instead.
Eat more fruit and vegetables. Aim for at
least five portions a day to provide you with
vitamins, minerals and fibre to help you
balance your overall diet. One portion is,
for example: a banana or apple, a
handful of grapes, a tablespoon of
dried fruit, a small glass of fruit juice
or fruit smoothie, three heapedtablespoons of vegetables or a
cereal bowl of salad.
Include more beans and lentils such
as kidney beans, butter beans, chickpeas
or red and green lentils. These have less of
an effect on your blood glucose levels and
may help to control your blood fats. Tryadding them to stews, casseroles and
soups, or to a salad.
Aim for at least two portions of oily
fish a week. Examples include mackerel,
sardines, salmon and pilchards. Oily fish
contains a type of polyunsaturated fat
called omega 3 which helps protect
against heart disease.
Limit sugar and sugary foods. This does not mean you need
to eat a sugar-free diet. Sugar can be used in foods and in baking
as part of a healthy diet. Using sugar-free, no added sugar or diet
fizzy drinks/squashes instead of sugary versions can be an easy way
to reduce the sugar in your diet. Sugary drinks are best used as atreatment for hypos.
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Reduce salt in your diet to 6g or less a day – more than this
can raise your blood pressure, which can lead to stroke and heart
disease. Limit the amount of processed foods you eat (as these are
usually high in salt) and try flavouring foods with herbs and spicesinstead of salt.
Drink alcohol in moderation only – that’s a maximum of 2
units of alcohol per day for a woman and 3 units per day for a
man. For example, a single pub measure (25ml) of spirit is about
1 unit or half a pint of lager, ale, bitter or cider has 1- 1 1 / 2 units.
Over the years the alcohol content of most drinks has gone up.
A drink can now contain more units than you think – a small glassof wine (175ml) could contain as much as 2 units. Never drink on
an empty stomach, as alcohol can make hypoglycaemia (low
blood glucose levels) more likely to occur. Remember, alcohol
contains empty calories so think about cutting back further if
you are trying to lose weight.
Don’t use diabetic foods or drinks. They offer no benefit
to people with diabetes. They will still affect your blood glucose
levels, contain just as much fat and calories as the ordinary
versions, can have a laxative effect and are expensive.
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Can I still have some sugar in my diet?
Yes. Eating sugar doesn’t cause diabetes and peoplewith diabetes do not need to have a sugar-free diet. It’sokay to have foods like chocolate and cakes occasionallyalongside a healthy diet. Remember, some sugary drinksand glucose tablets are a good first treatment for a hypo.
QA
I’d like to use a sweetener instead of sugar in mytea but I’ve heard that they aren’t safe. Is this true?
All sweeteners have to undergo rigorous safety testsbefore they can be sold in the UK. The government setssafe limits and surveys groups of individuals to seewhether they are exceeding these limits. At the momentthere is no evidence to suggest that the general public isexceeding these safe limits, but if you are at all concernedthen you can minimise any risk by using a variety ofsweeteners.
Q
A
Is it true that I shouldn’t eat bananas or grapes?
QA
Your questions answered
No. All fruit is good for you. Eating more fruit can reducethe risk of heart disease, some cancers and some gutproblems. Eat a variety of different fruit and vegetablesfor maximum benefit.
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Does a smoothie count towards my fruit and vegtarget?
Yes, a smoothie can be an easy way to notch up a portionof fruit. The good news is that if, for example, you put twowhole pieces of fruit into a homemade smoothie then itcan count as two portions. Remember that some smoothiescontain added sugar, honey, yogurt or milk that can bumpup the calories, fat or sugar content so check theingredients label.
Q
A
Can people with diabetes follow a vegetarian diet?Q
A
Is it ok for me to take a vitamin supplementnow that I have diabetes?
Diabetes UK does not recommend that people with diabetestake a supplement. If your diet is deficient in some nutrients
then you may benefit from taking one, but this should bedecided in conjunction with your doctor and/or dietitian.(Note: Women with diabetes should take a prescribablesupplement of 5mg of folic acid when planning pregnancyand continue to take it until the end of the 12th week ofpregnancy.)
Q
A
Yes, although, following a vegetarian diet does notautomatically mean a healthier diet. You still need to havea good balance of different foods. To make sure you arefollowing a healthy balanced vegetarian diet contact
The Vegetarian Society (details on page 22).
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What’s the best way to lose weight?
Making realistic and achievable changes to your diet andactivity levels will mean that you are more likely to stickto them in the long term. A dietitian can help with givingyou more specifc, personalised advice. If you are makingadjustments to your diet and/or activity levels you mayneed to also adjust your insulin doses. Talk to your diabetesteam for more advice on how this will best suit you.
Q
A
If you have Type 1 diabetes then you are much more at riskof developing coeliac disease because it is thought thatthey are both caused by an autoimmune response (whenthe body destroys its own cells). Diabetes UK recommends
that everyone with diabetes sees a registered dietitian. Thisis particularly important if you have coeliac disease too.Coeliac UK can also provide lots of useful information ona gluten free diet (details on page 22).
Q
A
I’ve heard there is a link between Type 1 diabetesand coeliac disease. How can I find out more?
Top tip…Ask your doctor to refer you to a registered dietitianwho can answer any specific questions you may have.
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A healthy balanceFoods can be divided into five main groups. To enjoy a balanced
diet we need to eat foods from these groups in the right
proportions. Use the eatwell plate to help you get the balance
right. It shows how much of what you eat should come from each
food group.
© Crown copyright material is reproduced with the permission of theController of HMSO and Queen’s Printer for Scotland.
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Getting the balance rightA good way to see whether you are achieving the rightbalance, is to think about how many portions of each of thesefoods you normally eat and see how it compares to the tablebelow. Remember, everyone’s nutritional needs are differentand you may need more or less portions than those suggested.
Bread, cereals, rice, pasta and potatoes. One portion is equal to:• 2–4 tbsp cereal • 2–3 tbsp rice, pasta, cous-cous,• 1 slice of bread noodles or mashed potato• half a small chapati • 2 new potatoes or half• 2–3 crispbreads or crackers a baked potato
Fruit and vegetables. One portion is equal to:• a banana or apple • a handful of grapes
• a slice of melon • a cereal bowl of salad• 2 plums • 3 heaped tbsp of vegetables• a small glass of fruit juice or smoothie
Meat, fish and alternatives. One portion is equal to:• 2–3 oz (60-85g) meat, poultry • 2 eggsor vegetarian alternative • 2 tbsp nuts
• 4–5 oz (120-140g) fish • 3 tbsp beans, lentils or dahl
Milk and dairy foods. One portion is equal to:• 1 / 3 pint milk • 2 tbsp cottage cheese• small pot yogurt • 1 1 / 2 oz cheese (40-45g, matchbox size)
Fatty and sugary foods. One portion is equal to:• 2 tsp spread, butter, oil, • 1 mini chocolate bar
salad dressing • 2 tsp sugar, jam or honey
• half a sausage • 1 scoop ice cream or 1 tbsp cream• rasher of bacon • half pack of crisps
Food groups and what’s in a portion
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7–14Include starchy foods at all meals.
5 or moreChoose a wide variety of
foods from this group, includingfresh, frozen, dried and tinned.
2–3Choose the lower fat alternativeswhenever possible and eat morebeans and pulses.
3Choose lower fat versions ofmilk and dairy foods.
0–4Cut down on sugaryand fatty foods.
How many portionsshould you eat in a day?
How many portionsdo you eat in a day?
Remember...
If you are trying to lose weight, the sizes of your portionsmay need to change. Check with your dietitian for morespecific advice.
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Know your labelsMaking sense of food labelling isn’t always easy. Both ‘Traffic light’
labelling and Guideline Daily Amounts (GDAs), on food and drinklabels, can be a starting point to help you to see how healthy or
unhealthy your food or drink is. They also allow you to compare
differences between brands.
Traffic light labellingThe traffic light colours, on the front of some packs, tell you
whether the product has low, medium or high amounts of fat,
saturated fat, sugars and salt. Examples of how these may look are
shown:
Red means high – keep an eye on how often you are choosing these
foods. Choose them less often or eat them in smaller quantities.
Amber means medium – it's okay to have some of the time but
when you have a choice, try to go for green.
Green means low – a healthier choice.
Most foods will have a mix of coloured lights so try to choose moreproducts with green and amber and less with red. You don't need
to avoid all foods high in fat, sugar or salt - it's the overall balance
of your diet that counts. Eaten occasionally, or in small amounts, red
foods won't significantly affect your overall diet. If the traffic light
label doesn't tell you enough, check the back of packs for detailed
information.
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Guideline Daily AmountsNot all manufacturers use the traffic light system so you may
see a Guideline Daily Amount (GDA) label on some of the foods
you buy such as the example below:
This label provides informationon the amount of sugar, fat,
saturated fat and salt as well
as the number of calories in
each portion of the product.
The percentages refer to the
proportion of the total
amount of the nutrient thatis recommended for an
average adult per day. These
figures are based on GDAs for
women to encourage people
who need less energy to
consume fewer calories.
This system requires a greater
level of interpretation than the
traffic light system.
For further information about food labelling, see Diabetes UK’s
useful credit card-sized, fold out leaflet, Know your labels
(code 7402).
19
6%
Calories
11612%
Sugars
11g1%
Fat
0.9g2%
Saturates
0.5g6%
Salt
0.3g Amount in product
% of adult guidelinedaily amount
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Foods labelled as ‘healthier’ choicesMost supermarkets are now offering their own ‘healthy-eating’
ranges. Although they can help you find healthier options, you
still have to think about how that food fits into your diet. It'simportant not to rely on foods marked as healthy eating options as
a healthy diet is made up of a variety of foods. Some products may
be labelled as low fat but still be high in sugar, and vice versa.
Products labelled 'low' contain less of that nutrient (ie fat, salt,
sugar etc) than those labelled 'reduced' - but whether a food is
labelled 'diet', 'light', 'low' or 'reduced', all of them are a
healthier choice than standard versions of the same food. Butbeware, the calorie, fat or sugar savings made by choosing these
versions may not be as great as you think – especially foods which
are high in fat and/or sugar anyway, eg cakes, biscuits and crisps.
Also, bear in mind that some foods are naturally low in fat,
sugar or salt, or high in fibre. Starchy foods like cereals and pasta
are always low in fat, yet some brands are sold with the claim
'low-fat food'.
IngredientsBy checking the ingredients list, you can really get to grips with
the food’s nutritional value. Remember, the ingredients are listed
from the highest ingredient first to the lowest ingredient last.
Carb countingFood labels can be a useful and convenient way of finding out the
carbohydrate content of foods and drink. Over the years food
labels have become a lot more detailed. Here are some tips to
help you use the food label to count carbohydrate:
• Double check whether the value you are using is per 100g.
If it is per portion or serving, what is the portion or serving size?
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• The amount of carbohydrate you should count is the ‘Total
carbohydrate’ rather than the ‘of which sugars’.
• Check whether the amount of carbohydrate is for the raw or
cooked product, especially with foods containing pasta or rice.• Consider what ingredients make up the product you are looking
at. If it is a food that contains a lot of very slowly digested
carbohydrates, such as beans or tomatoes you would not count
this carbohydrate. But the carbohydrate value will include them.
Check the ingredients list to get a sense of how much of these
foods are in the product.
For information about your grocery shopping visit the Diabetes
UK Store tour www.diabetes.org.uk/storetour
You may also be interested in reading these other related
Diabetes UK resources:
Diabetes UK publications
Understanding diabetes (free) (code 8002)
Weight creeping up on you? (free) (code 7500)
Know your labels (free) (code 7402)
Diabetes UK also has a range ofcookbooks.
To order telephone: 0800 585 088
U n d e r s t a n d i n g d i a b e t e s
Y o u r e s s e n t i a l g u i d e
K no w
y o u r l ab e l sY o ur guid e t o r ead ing f o o d labels
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Sources of support and information
Diabetes UK Careline
is here to help. Call 0845 120 2960 for support and information(although unable to provide individual medical advice). BT callfrom land lines cost no more than 4p per minute; calls from otherproviders and mobiles may vary.
Diabetes UK website
For an online store tour of Diabetes UK’s information guide to foodshopping, and menu planning visit www.diabetes.org.uk
Diabetes UK Publications Tel:0800 585 088
Diabetes Education Network www.diabetes_education.net
Food allergies
Coeliac UK, Suites A-D Octagon Court, High Wycombe, Bucks,HP11 2HS
Tel: 0870 444 8804 www.coeliac.co.uk
Allergy UK, 3 White Oak Square, London Road Swanley, Kent,
BR8 7AG
Tel:01322 619898 www.allergyuk.org
Anaphylaxis Campaign, PO Box 275, Farnborough, GU14 6SX
Tel: 01252 542029 www.anaphylaxis.org.uk
Special diets
The Vegetarian Society, Parkdale, Dunham Road, Altrincham,
Cheshire, WA14 4QGTel: 0161 925 2000 www.vegsoc.org
The Vegan Society, Donald Watson House, 21 Hylton Street,Hockley, Birmingham B18 6HJ
Tel: 0845 458 8244 www.vegansociety.com
Weight management
Weight Concern, Brook House, 2–16 Torrington Place, London,
WC1E 7HNTel: 020 7813 6636 www.weightconcern.com
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About Diabetes UKDiabetes UK is the charity for people with diabetes, their family,
friends and carers. Our mission is to improve the lives of peoplewith the condition and work towards a future without diabetes.
Diabetes UK is one of the largest patient organisations in Europe.
We stand up for the interests of people with diabetes by
campaigning for better standards of care. We are the largest
funder in the UK of research into better treatments for diabetes
and the search for a cure.
We provide practical support and information and safety-net
services to help people manage their diabetes.
How can you help?You can be actively involved in the work Diabetes UK does.
Become a membercall free on 0800 138 5605
Diabetes Campaigners Network
for details call 020 7424 1000
Email [email protected] www.diabetes.org.uk/campaigns
Fundraising ideas and events
call 020 7424 1000 Email [email protected]/fundraise
Make a donation
call 020 7424 1010 www.diabetes.org.uk/donate
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Diabetes UK
National and regional offices
Central Office Telephone 020 7424 1000
Diabetes UK Cymru Telephone 029 2066 8276
Diabetes UK Northern Ireland Telephone 028 9066 6646
Diabetes UK Scotland Telephone 0141 245 6380
Diabetes UK Eastern Telephone 01376 501 390
Diabetes UK East Midlands Telephone 0115 950 7147
Diabetes UK London Telephone 020 7424 1116
Diabetes UK Northern & Yorkshire Telephone 01325 488606
Diabetes UK North West Telephone 01925 653281
Diabetes UK South East Telephone 01372 720 148
Diabetes UK South West Telephone 01823 324007
Diabetes UK West Midlands Telephone 01922 614500
Visit www.diabetes.org.uk/in_your_area/ for email addresses
Useful contacts
Become a member Telephone 0800 138 5605
Customer Services Telephone 0845 123 2399Diabetes UK Careline Telephone 0845 120 2960*(or if hearing impaired) Textphone 020 7424 1031
Publications orderline Telephone 0800 585 088
Visit www.diabetes.org.uk for further information
*Diabetes UK Careline is here to help. Call 0845 120 2960 for support
and information (although unable to provide individual medical advice).BT call from landlines cost no more than 4p per minute; calls from otherproviders and mobiles may vary.
The charity for people with diabetesMacleod House, 10 Parkway, London NW1 7AA
Telephone 020 7424 1000 Fax 020 7424 1001
Email [email protected]
Website www.diabetes.org.ukA charity registered in England and Wales (no. 215199)
d i S tl d ( SC039136) © Di b t UK 2008